<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600385
Report Date: 06/15/2023
Date Signed: 06/15/2023 02:58:37 PM


Document Has Been Signed on 06/15/2023 02:58 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:CORINTHIAN GARDEN RESIDENTIAL CARE HOMEFACILITY NUMBER:
385600385
ADMINISTRATOR:ENCARNACION, WILLIAM S.FACILITY TYPE:
740
ADDRESS:170 APTOS AVENUETELEPHONE:
(415) 841-0311
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94127
CAPACITY:6CENSUS: DATE:
06/15/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Licensee/Administrator, William EncarnacionTIME COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On June 15, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted a plan of correction visit to ensure facility is in compliance with deficiency cited on 6/2/2023. LPA met with Licensee/Administrator, William Encarnacion and explained the purpose of the visit.

On 6/2/2023, LPA Charitra conducted a health and safety case management visit and observed toxins, chemicals, and sharps to be unlocked and accessible to residents. In addition, detergent and cleaning solution in the laundry room were observed to be unlocked.

On 6/14/2023, LPA Charitra and LPA Han conducted a plan of correction inspection to ensure facility is in compliance with citation issued on 6/2/2023. LPA Han observed sharps, toxins, chemicals, detergent and cleaning solutions were locked, however, they were locked with a white plastic cabinet slide lock that can be removed without a key which is accessible to residents. Due to the above observation and deficiency not being corrected, a civil penalty was assessed in the amount of $1,100.00 from 6/4/2023 through 6/14/2023.

On 6/14/2023, Licensee provided LPA Han and LPA Charitra with photos of locked cabinets where toxins, chemicals, and sharps are stored. Cabinets were observed with chains and a padlock. Deficiency is verified and cleared. Civil penalties are stopped as of 6/14/2023.

Report is reviewed with Licensee and a copy is provided.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Komal CharitraTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1